Anemia - Its New to Me So What's It Mean?

[sf925415]

I'm 33m crohns had resection surgery (resected termnnal ileum and surrounding) about 8 months ago. Now I am having mild anemea in the numbers, hemoglobin and hematoricrit a little low, and I was way low on iron saturation, and the iron numbers (ferriten) were in the normal range but on the llow end.
So now they have me on 3 pills of iron a day. And who knew - those cracks on the side of my mouth got better! And less dizzy. But the numbers are still low.

Why am I anemic? Cracks on the side of my mouth? Is that a bad sign or something? (I found online that cracked mouths can be sign of anemai, whicih I have rather interesting, as I have them and have had to be on steriodicalcream to treat them but the derm didn't think I might be anemic)Am I not absorbing iron cause I have less intestine? Or am I bleeding at the anastoma site?

Is all this oral iron good for me? Will I need to be on it forever?

 

[Sway15]

Okay, I'm not an expert on iron or anything. But I can only assume that taking it is good for you (i'm sure ur amount will decrease over time). Crohns has been known to cause iron deficieny in patients. Among other things like vitamins and essential nutrients the body craves.

I'm anemic and I'm on one pill a day because I guess mine was caught early? I'm new to the crohns thing. But i'm also inconsistant with taking pills so i would skip mine, lesson here is DO NOT SKIP UR IRON because it will leave you tired, dizzy, lightheaded. I take mine daily, there are days however where i still feel really tired but idk i'm thinking maybe i just need to make sure i take in enough liquids because crohns also makes it easy to be dehydrated SO DRINK WATER.

Also, you may be on iron for a long time...i asked my mother a similar question and she replyd "you'll be on it for as long as you need to" not helpful right? I know. At least the iron pills aren't that hard to get down.

Hope I helped.

 

[sf925415]

yes I get dizzier and the cracks on sides of my mouth come back when i stop the iron. that's tripping me out, like I've somehow entered a new level of crohns

 

[Sway15]

Now that you mention it i use to get cracks at the side of my mouth when i was younger esp in winter but since i've been on iron it hasn't really occured altho I thought that was because i'm on steroids. It's hard figuring out what causes what when you're on so many things. Honestly, you just need to watch what you eat, idk if you're on a really restricted diet or not but if it's flexible eat vegetables, fruits and drink water. If you eat greens and take your iron pills (this might sound gross) you may have green stool but that's just the iron doing that. Stay consistent and symptoms should decrease

 

[amssgirl]

As far as I remember (its been awhile since I took Science) anemia is a lower amount of red blood cells or hemoglobin in your system. This will affect the amount of oxygen that's able to be taken up in your bloodstream, which usually helps describe the symptoms of fatigue, dizziness, etc.

I'm no doctor, but I would definitely recommend taking the iron supplements. I believe the iron will help the red blood cells take up oxygen a lot better, and help with the symptoms of dizziness, etc. It may be worthwhile to research up on iron rich foods that your gut would agree with. I've heard of some foods that are known to cause more red blood cells to be generated, so maybe it is worth researching too and seeing if they can be part of your diet?

I think it would depend on the dosage of the iron too, maybe they're asking you to take the pill three times a day, but each pill is at a lower dosage (I don't know your situation, so I cannot say for sure).

All the best.

 

[DustyKat]

It is because you have had your terminal removed. This is the only area of the bowel that B12 is absorbed and the issues of malabsorption can also affect your levels of Folate.

You should be regularly monitored, via blood tests, for B12, Folate and Iron Stores. These are tests you will need to ask for, they aren't routine unless your doc is on top of your condition. Also be aware that you can have a normal haemoglobin but still be anaemic as your body will draw on it's iron stores.

Many people that have had terminal ileum resection require B12 injections for the rest of their life. My daughter has had a rather large resection and she falls into that group. My son has had a more conservative one, a little less than you, and we are monitoring at this point.

Dusty. xxx

 

[sf925415]

Okay thanks. They didn't check my b12 during the last few labs. But the iron sat, hemoglobin, hematocrit are below range and other iron numbers in low range. My hemicolectomy was 8 months ago and they took out about 12 inches including terminal ilieum, cecum, and additional surrounding area of intestines.

I still am fuzzy about whether the problem is due to inability to absorb? or actual active bleed? The absorption issue - that would be B12 directly, not iron right? I mean I think I heard that iron is absorbed in the duodenum which, as far as I know, is not diseased in me. I'm even more fuzzy about folic acid - I don't think they have ever checked that.

 

[outlier]

oral iron is can cause stomach upset, as well as dark stool. however it is fine to take but you should be monitored. many women are on iron of various amounts for most of there life.
a lot of people with anemia crave ice or develop pica if they are not on iron.
fainting and anemia really go together. I use to faint on the subway in the morning when i was anemic. good luck

 

[David]

Okay thanks. They didn't check my b12 during the last few labs. But the iron sat, hemoglobin, hematocrit are below range and other iron numbers in low range. My hemicolectomy was 8 months ago and they took out about 12 inches including terminal ilieum, cecum, and additional surrounding area of intestines.

I still am fuzzy about whether the problem is due to inability to absorb? or actual active bleed? The absorption issue - that would be B12 directly, not iron right? I mean I think I heard that iron is absorbed in the duodenum which, as far as I know, is not diseased in me. I'm even more fuzzy about folic acid - I don't think they have ever checked that.

If you had your terminal ileum removed, you absolutely positively need to have your Vitamin B12 monitored. Pretty much everyone with Crohn's Disease should for that matter, but if your TI is gone, 100%. That your doctors didn't mention this makes me angry and we see it a LOT on this forum.

Regarding iron, believe it or not, the human body only contains about 1-3 grams of iron of which about 80% will be used for red cell hemoglobin. In a healthy person, about 1mg of that is lost per day through normal processes such as losing skin cells as well as the mucosal lining of the intestines. Women on their periods lose about 2mg per day. I haven't read any studies on this yet, but I theorize people with Crohn's lose more of that lining than most which is part of the reason for iron issues. And yes, active bleeding could be another.

Iron absorption is primarily done in the duodenum and upper jejunum so if you have inflammation there (or had a resection) their absorption could be affected. In addition, various drugs can affect iron absorption such as proton pump inhibitors (think Prilosec) because they reduce gastric acid which lowers the PH in the duodenum which INCREASES iron absorption (some chemical process I don't fully understand yet). Plant phytates (think wheat) and tannins (coffee/non herbal tea) also inhibit iron absorption.

With all that said, ascorbate (vitamin C), citrate, and amino acids can improve iron absorption.

 

[DustyKat]

I still am fuzzy about whether the problem is due to inability to absorb? or actual active bleed? The absorption issue - that would be B12 directly, not iron right? I mean I think I heard that iron is absorbed in the duodenum which, as far as I know, is not diseased in me. I'm even more fuzzy about folic acid - I don't think they have ever checked that.

On the absorption side of things, yes it is more related to B12 than iron. It may be due to active bleed but not in the full flare type sense. My kids GI said to me at one point, particularly in view of Sarah being female and menstruating adding to the problem, that even when asymptomatic of CD you may still have a slight irritation of the bowel wall that leads to a slow insidious loss blood, much like a dripping tap. Nothing of note on a daily or weekly basis but over months can drop you into an anaemic range.

You must also have your Folate monitored as this is also absorbed in this area but not exclusively so. It is a complex process when it comes to absorption of B12, Iron and Folate but just always bear in mind that resection of the terminal and/or areas of the small bowel can affect the ability to absorb all of these. Extensive scarring will have the same effect.

Also look to your diet, I know with my daughter, she is now vegan, and others that red meat is something they avoid and other iron rich foods like leafy greens and cereals & grains can't be very well tolerated either. Unfortunately these are some of the foods that are the richest in iron. It is also unfortunate that many of the Folate rich foods are the very ones that many people with Crohns can't tolerate either.

Dusty. xxx

 

[sf925415]

yes I've been having what I think are appetite changes, like I cant eat all morning and then at night sometimes i make dinner and then can't take a bite without feeling disguisted. i just made a steak and potato which looked delicious and I was hungry, but I couldn't eat it for hours and then force fed 1/2 of the steak to myself, and tossed the potato. but then was starving later and could eat the simple carbs like crackers or snacks. Am I crazy? why does good food look disguisting?

Oh and I can't lie on my left side without causing at times severe pain in my right side where i presume the surgery was. I guess maybe its time to see the GI? I kind of just want to see if it gets better

 

[DustyKat]

My son's surgery was the 7th April this year and he had a total of 28.5cm of bowel removed including terminal ileum, caecum and large bowel. He is not having the issues with appetite or pain that you describe, his surgery was open as he also had fistula's and abscesses. Perhaps it is time to see your GI.

Dusty. xxx